The present invention pertains to the management of a bone fracture, and, more particularly, the use of an intramedullary system for managing a distal radius or similar bone fracture.
A distal radius fracture is a bone fracture of the radius in the forearm, and indeed, it is one of the most common bone fractures. Because of its proximity to the wrist joint, such a fracture is often referred to as a wrist fracture.
The management of distal radius fractures has evolved through many phases. In the 1950's and 1960's, closed reduction and immobilization (i.e., casting) were preferred forms of treatment. Unfortunately, in a large proportion of displaced distal radius fractures, casting was unable to maintain the alignment of the fragments and the reduction. Therefore, percutaneous pinning was added as an adjunct, and many variations of percutaneous pinning techniques were used.
In the 1980's, the management of distal radius fractures was mostly through external fixation. Many types of external fixation techniques were developed and used, including mobile external fixation systems. In addition to the external fixation, percutaneous fixation was also used in some circumstances.
In the 1990's, the trend shifted toward internal fixation, where a plate was applied to the dorsal surface of the radius. Although this form of internal fixation was generally successful, there were many problems with placement of thick metal plates on the dorsal surface of the radius where there was very little space for a plate. There were many reports of tendonitis and tendon rupture due to such plates rubbing against the tendons.
In the 2000's, the trend shifted toward putting the plate on the palmar surface of the radius—volar (palmar) radial plating. Volar locked plate systems are now a very common method of management of distal radius fractures around the world.
Although volar locked plate systems have improved the outcome of distal radius fractures in the short term, there is currently no firm evidence that this method of management of a distal radius fracture is any better than prior methods, such as external fixation, in the long run. There are also certain disadvantages in using volar locked plate systems, including increased possibility of tendon ruptures and the expense of management. Furthermore, as most distal radius fractures are extraarticular, some have opined that fixing all fractures with a strong, locked volar plate is “overkill” with respect to many distal radius fractures.